Provider Demographics
NPI:1255806113
Name:WEST, KRISTY (MA SPECIAL EDUCATION)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MA SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1126
Mailing Address - Country:US
Mailing Address - Phone:631-748-5693
Mailing Address - Fax:
Practice Address - Street 1:78 ONEIDA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1126
Practice Address - Country:US
Practice Address - Phone:631-748-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist